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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
Infertility continuing education social worker CEUs

Section 9
Stress Among Couples Starting Fertility Treatment

CEU Question 9 | CEU Test | Table of Contents
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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On the last track, we discussed a therapeutic approach to early and middle immersion.  This included separate sessions, using metaphors, tracking losses and the "mourning a miscarriage" technique.

On this track, we will discuss couple issues in the late immersion phase, the donor decision.  These will include genetic loss, egg donation as an "affair," sperm donation as "rape" and feeling like an impostor.  On the next track, we will discuss therapeutic approaches to the late immersion phase and the donor decision.

Donor insemination may be presented as the next logical step in the late immersion phase of infertility treatments.  Using donor gametes represents a qualitatively different choice, with profound consequences.  Because the child will be genetically related to only one of the partners, this treatment can be considered somewhat akin to adoption, with all the ensuing psychological complexity regarding disclosure to the child.  This complexity is compounded by the fact that partners do not share the same genetic relationship with the child, as opposed to families with either a jointly conceived or an adopted child.

When they are faced with the donor decision, couples may have been immersed in infertility treatments for some time.  They may be reeling from a series of treatment failures or from the shocking news that one partner’s gametes are not usable.  Therefore, they may be primed to grasp at any opportunity that will provide them with the possibility of a child.  However, if they rush into donor procedures without recognizing the complexities, once the child is born, they may be faced with disturbing feelings about disclosure, and confusion about the ensuing familiar relationships.

4 Couple Issues in Late Immersion

#1 Genetic Loss
First, let’s discuss genetic loss.  Partners who decide to use donor gametes (gah-meetz), that is sperm or eggs, both experience losses; however, their feelings may be different.  Although the experience of the partner who carries the infertility factor is more tangible, the fertile partner’s losses can be just as profound. 

The infertile partner must confront the fact that he or she will never be able to reproduce and there will be no child to carry forth that parent’s genetic legacy.  The fertile partner often feels grief over missing the experience of creating a child with his or her mate and of joining genetic material to create a child who has the traits of both parents.

Ronald, age 30, and Vera, age 28, were thinking about having a baby using donor sperm.  Vera stated to Ronald, during a session, "Everybody acts like we should be really happy that we have this option.  Well, I’m not!  I don’t want it.  I mean…we’ll have a baby and I’ll be happy, but I don’t want to just have a baby!  I want to have your baby!  I can never know exactly how you feel…but I think I’m extremely sensitive to the kind of loss that you’re experiencing…it was important for me that you understand that I’ve experienced a really profound loss too."

The couple may also be haunted by the "ghost" of the "real" child, the fully genetically related child they wanted to have together.  The "ghost" of the donor may also be present and, depending on the psychological makeup of the parents, may be relatively unimportant or may carry a great deal of meaning.  It is common for people to see the need for donor eggs or sperm as a physical failing. 

This can be compounded in clients who already have feelings of defect, shame, and failure deriving from their personal histories.  When the need for a donor is experienced as a traumatic event, a higher incidence of depression and a feeling that one has lost his or her center of control may ensue.

#2 Egg Donation as an "Affair"
Second, because the donated egg is fertilized with the male partner’s sperm, many men and women compare this procedure to an affair.  Women are typically more motivated to have a baby and are willing to undertake whatever procedures are necessary to achieve a pregnancy.  Nonetheless, they may be stricken with feelings of shame, envy, or resentment when they contemplate the union of their partner’s egg with those of another’s sperm.

Donor men may be titillated by the notion of creating a child with another woman, even if only with her genes.  The erotic fantasies touched off by their intimate association with another woman’s genes may produce feelings of guilt and shame.

Although men who fertilize donor eggs may not experience the sense of violation that women experience with donor insemination, some men may feel exploited.  Like women who receive donor sperm, men may resent their wives for obliging them to turn what is normally a natural, intimate, and sexually stimulating process into an artificially contrived arrangement.

Chad, age 32, was going to have a baby with his wife using a donor egg.  Chad stated, "You know, the creation of a child is supposed to be one of the most intimate things you can do, and yet this is one of the most detached things that has ever occurred in my life.  This is very upsetting…to me it’s almost an abstraction.  I’ve never even met this woman!  I’ve never had a cup of coffee with her!  I’ve never heard her voice!  I mean, this is an arrangement made by fax and phone!"

#3 Sperm Donation as "Rape"
Third, in addition to genetic loss and egg donation as an "affair," let’s discuss sperm donation as "rape."  Because sperm are imbued with more sexual connotations than eggs, women’s reactions to donor insemination may feel sexually violated, ashamed, angry or guilty.  Related to this sense of violation may be negative feelings about their partner’s.  They may feel betrayed because the man’s infertility made their donor insemination necessary.  At the same time, women may feel that they are committing infidelity by conceiving a child with another man’s sperm.

I have found that men often feel conflicted when they agree to proceed with donor insemination.  They may feel responsible that their partners have to undergo an emotionally distressing experience that has nuances of physical violation.  However, if they were to oppose donor insemination, they would be standing in the way of their partners’ desire to get pregnant and have a child. 

Once the decision is made to use donor insemination and the procedure has resulted in a pregnancy, worries about bonding with the child and feelings of being less "manly" may arise.  If men have no way of expressing their feelings especially to their partners, they may feel increasingly inadequate, angry or depressed.

#4 Feeling like an Impostor
Fourth, in addition to sperm donation as "rape," let’s discuss couples feeling like impostors. Many couples who achieve pregnancy through advanced infertility treatments may feel fraudulent, as though they have somehow "cheated" by arriving at their pregnancy through unorthodox means, and they may retain the infertile identity, the sense that they are flawed or defective.  This reaction can be greatly amplified when donor protocols are involved.  In these instances, one or both partners may be overwhelmed with the sense of being an impostor.

On this track, we have discussed late immersion phase, the donor decision.  These have included genetic loss, egg donation as an "affair," sperm donation as "rape" and feeling like an impostor.

On the next track, we will discuss a therapeutic approach to this late immersion phase.  This will include thinking about the donor option, couple communication about donorship, alienation versus attachment and ongoing "check-in" questions about infertility.

Peer-Reviewed Journal Article References:
Casu, G., Zaia, V., Fernandes Martins, M. d. C., Parente Barbosa, C., & Gremigni, P. (2019). A dyadic mediation study on social support, coping, and stress among couples starting fertility treatment. Journal of Family Psychology, 33(3), 315–326. 

Darwiche, J., Favez, N., Maillard, F., Germond, M., Guex, P., Despland, J.-N., & de Roten, Y. (2013). Couples’ resolution of an infertility diagnosis before undergoing in vitro fertilization. Swiss Journal of Psychology, 72(2), 91–102. 

Diamond, D. J. (2011). Review of Ethical dilemmas in fertility counseling [Review of the book Ethical dilemmas in fertility counseling, by J. Horowitz, J. Galst & N. Elster]. Families, Systems, & Health, 29(1), 73–76. 

Pelham, B. (2019). Life history and the cultural evolution of parenting: Pathogens, mortality, and birth across the globe. Evolutionary Behavioral Sciences. Advance online publication.

Quinn, G., Bleck, J., & Stern, M. (2020). A review of the psychosocial, ethical, and legal considerations for discussing fertility preservation with adolescent and young adult cancer patients. Clinical Practice in Pediatric Psychology, 8(1), 86–96.

Online Continuing Education QUESTION 9
What are four issues that couples face in the late immersion phase? To select and enter your answer go to CEU Test.

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